Alyssa Lane
In the United States, there are several ways to insure children outside of the yearly Open Enrollment Period. If your child is under 26, they can be added to their parent or guardian's insurance plan during a Special Enrollment Period. Special Enrollment Periods are triggered by specific life events, such as having a child, getting married, losing health coverage, or qualifying for Medicaid or CHIP. If you have recently experienced any of these life changes, you may be eligible for a Special Enrollment Period, allowing you to sign up for health insurance outside of the regular Open Enrollment Period. Additionally, some states offer extended coverage options, such as the Age 29 law in New York, which allows young adults to elect COBRA/state continuation coverage for up to 36 months. It's important to check with your state's Department of Insurance for specific rules and options.
| Characteristics | Values |
|---|---|
| Special Enrollment Period | You qualify for a Special Enrollment Period if you've had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount. |
| Losing health coverage | You may qualify for a Special Enrollment Period if you lose individual health coverage, including if your individual plan or your Marketplace plan is discontinued or if you lose eligibility for a plan because you no longer live in the plan's service area. |
| Gaining a dependent | If you have a child, you may qualify for a Special Enrollment Period and can add them to an existing Marketplace plan. |
| Parent's insurance | Young adults can remain on a parent's health plan until the age of 26. |
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What You'll Learn
Losing health coverage
If you've lost health coverage, there are several scenarios that may apply:
- Loss of Coverage Through a Parent, Spouse, or Family Member: If you were previously covered by a parent's, spouse's, or family member's plan and lost that coverage, you may qualify for an SEP. This could happen if you turn 26 (or the maximum dependent age in your state) and age out of your parent's plan, or if the family member loses their coverage or coverage for their dependents.
- Divorce or Legal Separation: Losing health coverage due to divorce or legal separation can qualify you for an SEP. However, if you retain coverage after the divorce or separation, you won't be eligible.
- Death of a Family Member: If someone on your Marketplace plan passes away, causing you to lose your current health plan, you will qualify for an SEP.
- Moving: Moving to a different location can impact your health coverage, especially if you move outside the plan's service area. You may qualify for an SEP if you move to a different state or country and need to change your health insurance plan as a result.
- Income Changes: If your household income decreases, you may qualify for savings on a Marketplace plan and be eligible for an SEP. On the other hand, an increase in income that makes you ineligible for certain coverage, such as Medicaid, may also trigger an SEP.
- Change in Eligibility: Losing eligibility for a student health plan or a group health plan in the middle of the calendar year can qualify you for an SEP. Additionally, if you lose or are denied Medicaid or the Children's Health Insurance Program (CHIP) coverage due to changes in eligibility criteria, you may be eligible for an SEP.
- Discontinuation of Plan: If your individual plan or Marketplace plan is discontinued and no longer exists, you will likely qualify for an SEP.
It's important to note that the rules and requirements for SEPs may vary depending on your state and specific circumstances. Additionally, you may be required to provide proof of the qualifying life event that triggered the loss of coverage.
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Qualifying for Medicaid or CHIP
Financially, eligibility is based on Modified Adjusted Gross Income (MAGI), which is used to determine eligibility for Medicaid, CHIP, and premium tax credits and cost-sharing reductions available through the health insurance marketplace. Non-financially, CHIP beneficiaries must be residents of the state in which they are receiving CHIP, and they must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents.
Infants born to targeted low-income pregnant women are automatically eligible for Medicaid or CHIP without an application or further determination of eligibility. They are covered until they turn one year old. States can also provide deemed eligibility to children born to mothers who, on the date of the child's birth, are covered as targeted low-income children under CHIP. Additionally, all states must offer young people transitioning from foster care to independent adulthood (former foster care children) Medicaid coverage until they turn 26, provided they meet certain conditions.
If you lose your Medicaid or CHIP coverage, you may qualify for a Special Enrollment Period. This could be because your Medicaid eligibility changed due to a change in household income, or because you lost your coverage for another reason, such as your individual plan being discontinued or losing eligibility for a student health plan.
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Getting married or divorced
In the US, young adults can remain on their parent's health insurance plan until they turn 26. This rule applies to both married and unmarried children and across all states. However, some states and plans have different rules, so it's important to check with the employer or plan provider to confirm. For example, in some states, coverage can be extended until the age of 30, depending on the child's marital status, whether they are a veteran, their disability status, or whether they have children. Additionally, children with disabilities can remain on their parent's health insurance indefinitely in certain states.
Losing coverage on a parent's plan when a young adult turns 26 is considered a qualifying event that triggers a special open enrollment period. This allows the young adult to enrol in individual health insurance or a group plan through their employer if they are eligible. It is important to note that special enrollment in another employer plan must typically be requested within 30 days of losing coverage.
Now, turning to the specific scenario of getting married or divorced outside of the open enrollment period:
Marriage is considered a qualifying life event that allows individuals to enrol in a Special Enrollment Period for health insurance. This means that if you recently got married, you can enrol in a health insurance plan outside of the typical open enrollment period. To do so, simply pick a plan by the last day of the month, and your coverage can start the first day of the next month.
Similarly, divorce or legal separation is also considered a qualifying life event for the Special Enrollment Period. If you are going through a divorce or legal separation and lose your health insurance as a result, you may enrol in a new health insurance plan. Your coverage can start the day of the event, even if you enrol in a plan up to 60 days afterward.
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Having a baby or adopting a child
You may qualify for a Special Enrollment Period if you've had certain life events, including having a baby or adopting a child. This period is outside the yearly Open Enrollment Period, when you can sign up for health insurance. If you've had a baby or adopted a child in the past 60 days, your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.
If you've recently had a baby or adopted a child, you may be able to add them to your existing health insurance plan. Contact your insurance provider or employer's benefits department to find out how to do this. You may be able to add your child to your plan, even if you are not their biological parent.
If you don't currently have health insurance, you may be able to enroll in a plan during the Special Enrollment Period. You can sign up for a plan through the Marketplace or through your employer. If you're enrolling through the Marketplace, you may be able to get savings on your premiums if your household income is below a certain amount.
If you've lost health coverage in the past 60 days or expect to lose coverage in the next 60 days, you may also qualify for a Special Enrollment Period. This includes losing coverage through your employer or losing Medicaid or CHIP coverage. Keep in mind that if you choose to drop your coverage as a dependent, you'll need to have a decrease in household income or a change in your previous coverage to qualify for a Special Enrollment Period.
It's important to note that the rules and requirements for health insurance may vary depending on your state and insurance provider. Be sure to review the specific details of your plan or contact your insurance company for more information.
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Turning 26
In the United States, the Affordable Care Act requires plans and issuers that offer dependent child coverage to make the coverage available until the child reaches the age of 26, whether they are married or unmarried. This rule applies to all plans in the individual market and to all employer plans.
If you are on your parent's employer-based health insurance plan, your coverage will usually last through the month of your 26th birthday. For example, if your birthday is on May 1, your coverage will continue through May 31. If you are on your parent's marketplace plan, your coverage will end on December 31 of the year you turn 26, regardless of your birthday.
Once you turn 26, you may be able to sign up for your job's health insurance plan. Your birthday does not need to fall inside the usual enrollment period. You can also enroll in a Health Insurance Marketplace Plan. The federal government operates the Health Insurance Marketplace, but some states run their own marketplaces. You can apply at HealthCare.gov or your state's marketplace website. During the application process, you will find out if you are eligible for Medicaid or the Children's Health Insurance Program (CHIP). If you have a limited income or are pregnant, you may qualify. These plans are independent of your employer, so you will have to pay the premium on your own. When you apply, you may qualify for subsidies.
If you are losing your parents' coverage, you may be eligible for special enrollment in another employer plan. Special enrollment must be requested within 30 days of your loss of coverage. If your parents' plan is sponsored by an employer with 20 or more employees, you may be eligible to purchase temporary extended health coverage for up to 36 months under the Consolidated Omnibus Budget Reconciliation Act (COBRA). To elect COBRA coverage, notify your parents' employer in writing within 60 days of reaching age 26. You will then have 60 days from the date the notice was sent to elect COBRA coverage. If your parents' plan is sponsored by an employer with 20 or fewer employees, you may have similar rights under state law.
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Frequently asked questions
You may qualify for a Special Enrollment Period if you have experienced certain life events, such as losing health coverage, moving, getting married, having a baby, or adopting a child. You can also apply for Medicaid or the Children's Health Insurance Program (CHIP) at any time of the year as long as you meet the eligibility requirements.
The Special Enrollment Period is a period of time outside of Open Enrollment when you can enroll in or change Marketplace plans.
Your child can remain on your health insurance plan until they turn 26, regardless of whether they live with you, are financially independent, have other coverage options, are a student, or are married.
